Latent Varicella Zoster Virus Research Articles

Neuralgia Pasca Herpes

Herpes zoster, also known as snake pox and shingles , is a skin disease caused by reactivation of latent varicella zoster virus (VVZ) infection also known as human herpesvirus-3 (HHV-3) in the dorsal root sensory ganglion after primary infection. Mrs. A, 64 years old female was consulted with complaints of burning pain in the lower right abdomen to the right waist, that happened approximately 2 month after diagnosed with herpes zoster. Based on anamneses and physical examination the patient was diagnosed by Postherpetic neuralgia. Postherpetic neuralgia is persistent chronic pain and the most common complication in herpes zoster. In the majority of patients, pain from shingles is usually felt within 2 to 4 weeks. However, patients who experience NPH will experience continuous pain at the site of infection for 3 to 9 weeks after infection. The patients was given supportive treatment accompanied by education that can be provided to relieve the symptoms caused by this disease.

BioNTech COVID-19 (BNT162b2) Vaccination and Varicella Zoster Reactivation: A Comprehensive Cross-sectional Study.

Herpes zoster (HZ) results from reactivation of latent varicella-zoster virus. Recent observations have suggested that HZ is associated with vaccination against COVID-19. To investigate the association between the vaccine and HZ severity, a single-centre, cross-sectional study of all patients diagnosed with HZ and 2 control diagnoses (cellulitis and bone fractures), between 2017 and 2021, was performed. Hospital visits and hospitalization rates were compared. All medical records of patients diagnosed with HZ in the first year after the COVID-19 vaccination campaign began were reviewed, in order to generate a retrospective cohort comparing vaccinated and unvaccinated patients with HZ. All participants had received the Pfizer-BioNTech COVID-19 (BNT162b2) vaccine. During the study period, 2,413 patients were diagnosed with HZ, and when normalized to control diagnoses the number of cases remained stable. The retrospective cohort included 365 patients. A multivariate analysis controlling for sex, age, autoimmune diseases, malignancies, and immunosuppressive therapy showed higher admission rates in vaccinated compared with unvaccinated individuals (odds ratio (OR) 2.75, 95% CI 1.27-5.96, p = 0.01). However, matching techniques and stratification by age, used to better control for confounders, invalidated these findings. No differences were observed in other variables indicative of disease severity (hospital stay length and complications). In conclusion, COVID-19 vaccination was not found to be associated with an increased risk of HZ-related admission and complications.

Herpes Zoster in Palate: Atypical Presentation in Immunosuppressed Patient Secondary to Rituximab, a Case Report and Review of Clinical Manifestations and Management

Herpes zoster (HZ) is caused by the reactivation of the latent varicella zoster virus (vZv). The cause of reactivation may be associated with predisposing factors such as age, stress or the impaired immune system and an association with autoimmune diseases has been seen. Its clinical presentation is characterized by the appearance of multiple vesicles that rupture quickly, leaving small, very painful ulcers that are distributed respecting specific dermatomes. The diagnosis in most cases is clinical, and complementary tests may be necessary and differential diagnoses may be excluded in cases of atypical presentation. The main sequelae after the disappearance of skin signs is postherpetic neuralgia, which is more common in the elderly. Early diagnosis and rapid initiation of treatment determine the prognosis, especially in immunocompromised individuals. In this work we report a case of atypical clinical presentation in a woman with autoimmune disease, immunocompromised and belonging to the elderly population, being a clear example of the patient in whom special attention should be paid when establishing the diagnosis with the aim of emphasizing early detection and rapid establishment of appropriate treatment, avoiding deleterious outcomes.

Herpes zoster ophthalmicus

Herpes zoster ophthalmicus (HZO) occurs when latent varicella zoster virus reactivates in the ophthalmic division of the fifth cranial nerve (CNV1). HZO commonly affects older and immunocompromised patients. This disease is considered an ophthalmic emergency due to the wide range of associated ocular symptoms, including severe chronic pain and vision loss. HZO is typically a clinical diagnosis due to its classic presentation of a unilateral vesicular eruption in the dermatomes corresponding to CNV1. Timely treatment is imperative to minimize ocular morbidity in HZO, given that ocular involvement is present in 50% of affected patients.

Herpes zoster in an immunocompetent child: A case image

Herpes zoster (HZ) results from reactivation of latent varicellazoster virus primary infection (varicella). This condition appears to be less common in children and to have a favorable outcome in immunocompetent children. The diagnosis is clinical and the characteristic exanthema

Progressive shingles in a toddler due to reactivation of Varicella Zoster vaccine virus four days after infection with SARS-CoV-2; a case report

BackgroundHerpes zoster (HZ) is the clinical syndrome associated with reactivation of latent varicella-zoster virus (VZV). Several factors have been implicated to promote VZV reactivation; these include immunosuppression, older age, mechanical trauma, physiologic stress, lymphopenia, and more recently, infection with severe acute respiratory syndrome coronavirus-2 (SARS- CoV-2). Recent reports suggest an increase in the number of HZ cases in the general population during the global COVID-19 pandemic. However, it is unknown what proportion of HZ during the pandemic is due to reactivation of wild-type or vaccine-strain VZV.CaseHere we report the first known case of HZ concomitant with SARS-CoV2 infection in a 20-month-old female who was treated with a single dose of dexamethasone, due to reactivation of the vaccine-type strain of VZV after presenting with a worsening vesicular rash.ConclusionIn this case, we were able to show vaccine-strain VZV reactivation in the context of a mild acute symptomatic COVID-19 infection in a toddler. Being able to recognize HZ quickly and effectively in a pediatric patient can help stave off the significant morbidity and mortality associated with disease process.

The immunogenicity and the safety of the adjuvanted glycoprotein E (gE)-based recombinant vaccine against herpes zoster (RZV) in cancer patients during immunotherapy

ABSTRACT Herpes zoster (HZ) is caused by the reactivation of latent varicella zoster virus (VZV). Severe immunocompromising conditions, such as solid tumors, have been largely associated with an increased risk for HZ due to waning VZV-specific cellular immunity. With the approval of the adjuvanted glycoprotein E (gE)-based recombinant vaccine (RZV; Shingrix™, GSK) also in immunocompromised subjects, HZ is considered a vaccine-preventable disease changing perspectives in immunocompromised subjects. To date, no clinical trial has evaluated the immunogenicity in the patients with cancer undergoing immunotherapy. In this study, we describe the humoral and cell-mediated immune responses in 38 cancer patients treated with immune checkpoint inhibitors (ICIs) and receiving RZV. We used samples collected at baseline (T0), 3 weeks (T2), and 6 months (T3) after the complete RV vaccination schedule. Our data showed that a significant proportion (40,5%) of RZV recipients mounted a stronger humoral and cell-mediated immune response at 3 weeks (T2) after complete RZV vaccination schedule. Interestingly, both humoral and cell-mediated immune responses were mostly stable over 6 months (T3). Interestingly, the overall IFNγ-producing lymphocytes was mainly associated with CD4 T cell response (p = .0012). In conclusion, data from our pilot study suggest a strong and long-lasting immunogenicity of RZV in ICI-treated patients. Prospective analyses at 1 year after vaccination will be performed in order to evaluate the long-term persistence of humoral and cell-mediated response against RZV.

Immunogenicity in Mice Immunized with Recombinant Adenoviruses Expressing Varicella-Zoster Virus Envelope Glycoprotein E.

Herpes zoster (HZ) is a disease caused by the reactivation of latent varicella-zoster virus (VZV). The subunit vaccine, Shingrix®, and live attenuated vaccine, Zostavax®, could be used as an HZ vaccine that prevents HZ from being developed due to the reactivation of latent VZV in the sensory ganglia due to aging, stress or immunosuppression. In this study, the recombinant adenoviruses rChAd63/gE expressing glycoprotein E (gE) of VZV based on chimpanzee adenovirus serotype 63 (ChAd63) were constructed and investigated for the immunogenicity of different immune pathways in C57BL/6 mice. The results showed similar CD4+ T and CD8+ T cell responses to Shingrix® were induced in mice vaccinated using rChAd63/gE via different immune pathways. This study elucidates that recombinant adenoviruses expressing VZV gE could be appropriate for further development as a new HZ vaccine candidate via different immune pathways.

Herpes zoster and postherpetic neuralgia progression rate: an epidemiological study at Tertiary Hospital in Bali, Indonesia

Link of Video Abstract: https://youtu.be/bmHkb4pnp9I Background: Herpes zoster is an infectious disease caused by the reactivation of the latent varicella zoster virus. One of the complications that has the potential to cause long-term problems is post-herpetic neuralgia. This study aims to evaluate the Herpes zoster and postherpetic neuralgia progression rate: an epidemiological study at Tertiary Hospital in Bali, Indonesia Methods: This is a retrospective descriptive cross-sectional study. The data was obtained from the patient's medical records in Dermatovenereology Clinic at Sanglah General Hospital Denpasar from January 2020 to December 2021. The samples were all new patients diagnosed with herpes zoster and post-herpetic neuralgia. The variable is sex, age, occupation, comorbid, and location. Data were analyzed using SPSS version 25.0 for Windows. Results: A total of 23 new patients were diagnosed with herpes zoster and the total visit was 132. Most patients were male 12 (52.3% vs 47.7%). The highest age group was more than 65 years old with 12 (51.5%) patients, followed by 45-64 years with 8 (35.6%) patients. The lesion location in most patients was thoracic in 9 patients (38.1%), followed by cervical in 7 patients (29.5%), lumbar in 6 patients (25.8%), and ophthalmic in 1 patient (6.6%). Six patients (26.0%) had comorbid diseases. Ten patients experienced PHN. Conclusion: Most herpes zoster patients in Dermatovenereology Clinic, Sanglah Hospital from January 2020 to December 2021 were more than 65 years old, predominantly male sex, with the most common location of herpes zoster in the thoracic region 9 patients (38.1%), and 10 patients (43.5%) had PHN.

No Varicella Zoster Virus Infection among Mpox Cases in Antwerp, Belgium.

Several studies in tropical settings have reported that ∼20% of patients infected with Monkeypox virus (MPXV) also tested polymerase chain reaction (PCR) positive for Varicella zoster virus (VZV). Researchers have hypothesized that VZV infection predisposes to monkeypox (mpox), or vice versa, or that MPXV triggers the reactivation of VZV. We tested samples for VZV from a cohort of patients infected with clade IIb MPXV diagnosed between May 23 and October 14, 2022 in Antwerp, Belgium. Leftover DNA extracts of skin lesion samples from 108 mpox patients were tested with in-house PCR for VZV. No VZV infections were found. The absence of concurrent VZV-MPXV infections in our cohort indicates that VZV did not cocirculate in the population at risk for MPXV during the Belgian 2022 outbreak, but also that MPXV does not commonly trigger reactivation of latent VZV in adult men.

Association between COVID-19 infection and herpes zoster: A case series

Herpes zoster (HZ) is a manifestation of the reactivation of latent varicella zoster virus (VZV) infection in the dorsal root ganglion. The occurrence of HZ has been reported in association with COVID-19. Herein, we describe 10 cases who developed classic HZ within 2–3 weeks of acquiring COVID-19 infection. The triggers in these patients could be severe stress (related to quarantine issues, fear of hospitalisation and death) immune dysregulation and systemic steroid therapy in treating COVID-19. The clinical patterns and therapeutic responses observed were similar to HZ in immunocompetent persons. Increased expression of NKG2A on NK and CD8+ T cells has been proposed as a pathophysiologic mechanism in triggering HZ at the molecular level in COVID-19 patients. Primary physicians should be aware of this association to counsel and treat such patients appropriately, as initiating early treatment could minimise the risk of complications like postherpetic neuralgia.

Multi metameric genital shingles A rare case in an immunocompetent child

Shingles is a viral dermatosis caused by the reactivation of the latent varicella zoster virus occurring usually after a primary varicella infection.

Hospitalization burden related to herpes zoster infection during the COVID-19 pandemic in Spain (2020-2021)

ABSTRACT Varicella-Zoster Virus (VZV) belongs to the family Herpesviridae. Herpes zoster (HZ) is caused by reactivation of latent VZV. It is associated with risk factors such as immunosenescence, immunosuppressive pathologies and pharmacological treatments. Patients with these risk factors are more likely to be hospitalized. Increases in HZ hospitalizations have been reported in many countries in recent years. The objective of this study is to estimate hospitalization rates, mortality rates and costs due to HZ during the worst years of the COVID-19 pandemic in Spain (2020–2021). This is a descriptive study based on an analysis of information from the Minimum Basic Dataset and coded according to the Spanish version of the 10th International Classification of Diseases (ICD-10-CM). Hospitalization, mortality and case-fatality rates, and median length of hospitalization were calculated.. The hospitalization rate was 14.4 cases per 100,000 inhabitants, and the mortality rate was 1.3 cases per 100,000 inhabitants. Both increased considerably with age. In this time period, 92.3% of the registered cases were people over 50 years of age. Nevertheless, during the COVID-19 pandemic period, hospitalization rate decreased and the mortality rate increased from previous years. HZ hospitalization and mortality rates are relevant issues in the public health of older people. It is highly recommended to evaluate new vaccination strategies against VZV to include the HZ vaccine for health care for elderly people, as well as to reduce the disease burden and associated risk factors. The estimation of HZ disease hospitalization costs were €100,433,904.

Herpes zoster vaccination recommendations ofthe group of experts of the Polish Society of Vaccinology,the Polish Society of Family Medicine, the Polish Societyof Dermatology, the Polish Association for the Studyof Pain and the Polish Neurological Society

Shingles is an infectious viral disease, a symptomatic reactivation of latent varicella-zoster virus infection (VZV). Its naturalhistory usually involves formation of blisters on erythematous skin, preceded by pain and encompassing the area of a singledermatome. Most vulnerable populations include individuals over 50 years of age as well as high-risk patients. Seriouscomplications can develop in the course of the disease, with post-shingles neuralgia being the one of the highest clinicalimportance; it develops in as many as 30% of all patients, resulting in considerable suffering and reduction in the qualityof life. The treatment of post-shingles neuralgia is lengthy and frequently inefficient, posing a significant challenge forhealthcare systems. Vaccinations are the most efficient form of protection against shingles and its related complications.Due to the epidemiology of infections and their complications, vaccinations are recommended in all individuals over the ageof 50 as well as in younger adults (18 years or older) with the disease risk factors.

Varicella-zoster virus proteome-wide T-cell screening demonstrates low prevalence of virus-specific CD8 T-cells in latently infected human trigeminal ganglia

BackgroundTrigeminal ganglia (TG) neurons are an important site of lifelong latent varicella-zoster virus (VZV) infection. Although VZV-specific T-cells are considered pivotal to control virus reactivation, their protective role at the site of latency remains uncharacterized.MethodsPaired blood and TG specimens were obtained from ten latent VZV-infected adults, of which nine were co-infected with herpes simplex virus type 1 (HSV-1). Short-term TG-derived T-cell lines (TG-TCL), generated by mitogenic stimulation of TG-derived T-cells, were probed for HSV-1- and VZV-specific T-cells using flow cytometry. We also performed VZV proteome-wide screening of TG-TCL to determine the fine antigenic specificity of VZV reactive T-cells. Finally, the relationship between T-cells and latent HSV-1 and VZV infections in TG was analyzed by reverse transcription quantitative PCR (RT-qPCR) and in situ analysis for T-cell proteins and latent viral transcripts.ResultsVZV proteome-wide analysis of ten TG-TCL identified two VZV antigens recognized by CD8 T-cells in two separate subjects. The first was an HSV-1/VZV cross-reactive CD8 T-cell epitope, whereas the second TG harbored CD8 T-cells reactive with VZV specifically and not the homologous peptide in HSV-1. In silico analysis showed that HSV-1/VZV cross reactivity of TG-derived CD8 T-cells reactive with ten previously identified HSV-1 epitopes was unlikely, suggesting that HSV-1/VZV cross-reactive T-cells are not a common feature in dually infected TG. Finally, no association was detected between T-cell infiltration and VZV latency transcript abundance in TG by RT-qPCR or in situ analyses.ConclusionsThe low presence of VZV- compared to HSV-1-specific CD8 T-cells in human TG suggests that VZV reactive CD8 T-cells play a limited role in maintaining VZV latency.

Homoeopathic Treatment of Childhood Herpes Zoster—A Case Series

Abstract Background Herpes zoster (HZ) is a relatively rare infectious disease in the paediatric population as compared to adults, occurring due to the reactivation of latent varicella-zoster virus that persists in the posterior root ganglion. HZ can develop any time after the primary infection and is characterised by grouped vesicular rashes limited to single dermatome. Diagnosis is based on a distinct clinical appearance of HZ. Its clinical course is variable, and it requires prompt medical treatment to prevent the complications. In conventional method, antiviral and other treatment modalities are available; however, these are fraught with potentially severe side effects and is expensive that demands an alternative method of treatment. Methods A case series of three children with HZ treated with individualised homeopathy is presented here. The cases are reported according to HOM-CASE guidelines and followed up with photographic documentation. The Modified Naranjo Criteria for Homeopathy (MONARCH) inventory was used as a tool for assessing the causal relationship between homeopathic intervention and clinical outcome. Results All cases of HZ were successfully cured with individualised homoeopathy within 10 days without any complication. Individual curative response of the homoeopathic medicine in each case was assessed through MONARCH which demonstrated a positive causal attribution of homeopathy. Conclusion Successful results of this case series suggest a positive response of individualised homeopathic medicines in the treatment of childhood HZ. The remissions of the HZ lesion presented in this case series may be attributed to homeopathic medicines in each case. Hence, this case series could serve as a basis for further research into the role of individualised homeopathic medicine in the treatment of childhood herpes zoster.

AB1596 REAL-LIFE STUDY OF IMMUNOGENECITY AND SAFETY OF THE RECOMBINANT VACCINE AGAINST VARICELLA ZOSTER VIRUS IN PATIENTS WITH RHEUMATIC DISEASES TREATED WITH JANUS KINASE INHIBITORS

BackgroundAdjuvanted recombinant varicella zoster virus subunit vaccine (ARZVV) has been recently approved for preventing reactivation of latent varicella zoster virus in selected groups of patients. Patients with chronic inflammatory diseases are at major risk of this reactivation, developing herpes zoster (HZ) infection (shingles). This risk is further increased under immunosuppressive treatment with janus kinase inhibitors (JAKi). ARZVV is available in Spain since March 2021 for patients treated with JAKi, among other indications. At the present, no real-life post commercialization studies have been published in patients with rheumatic diseases and JAKi vaccinated with ARZVV.ObjectivesTo assess humoral immunogenicity and safety of ARZVV in patients with rheumatic diseases treated with JAKi.MethodsImmunogenicity and short-term safety were evaluated in a cohort of patients treated with Janus Kinase inhibitors in a descriptive prospective study. Participants received two intramuscular doses of the vaccine two months apart. Blood was sampled prior to first and 2-6 weeks after the second vaccine dose. Humoral immune response was tested through a chemiluminescence immunoassay (CLIA), using varicella zoster virus glycoprotein E (gE) as the antigen to measure anti-gE levels. The cut-off for the vaccine response assessment was considered an antibody concentration four times higher in the second measure, compared with the first one, according to the results of the clinical trialNCT01165177. The influence of the different treatments on the humoral response to the vaccine was evaluated. JAKi were separated in three groups, according to their mechanism of action: inhibition of JAK 1 (Upadacitinib and Filgotinib), inhibition of JAK 1 and JAK 2 (Baricitinib) and panJAK inhibition (Tofacitinib). Concomitant treatment influence on the humoral response to the vaccine was also determined: classic disease modifying anti-rheumatic drugs (DMARDs) and corticosteroids. The data about adverse events to the vaccination, disease flare or reactivation on HZ infection were collected.ResultsWe enrolled 30 patients, 23 were woman (76,7%), with a mean age of 55±12 years. Fifteen (50%) were under treatment with upadacitinib, eleven (36,7%) with baricitnib, two (6,7%) with filgotinib and two (6,7%) with tofacitinib. Six (20%) had concomitant treatment with methotrexate and 5 (16,7%) with leflunomide. Ten (33%) had low dose prednisone. Four (13%) reported clinically HZ previously.We found that 16 patients (53,3%) reached the response assessment marked initially of quadrupling their initial antibody count. Type of JAKi did not significantly influence the humoral response, neither did the concomitant treatment with disease-modifying antirheumatic drug or low dose glucocorticoid. Fiftheen patients (50%) presented mild adverse effects; 7 (23%) of them consisted in injection-side pain, and 8 (26,7%) were systemic (myalgia, fatigue or fever). One patient (3,3%) had an ischemic cerebrovascular complication 2 weeks after the first dose. None of the patients presented a disease flare in the following 4 weeks postvaccination, neither HZ infection after 7 months of follow-up.ConclusionLightly more than half of the patients (53%) with rheumatic diseases treated with JAKi reached the immune response assessment stablished. In clinical trials with non-rheumatic immunosuppressed patients, the response was ranged between 65-96%. This difference could be explained due to that it is a real-life study and in the type of disease and immunosuppression. Safety and prevention of HZ infection was high. To confirm these results higher number of patients is needed.

Treatment with Brivudine in Immunocompromised Pediatric Patients with Herpes Zoster

Introduction: Herpes zoster (HZ) is caused by endogenous reactivation of latent varicella-zoster virus (VZV) that persists in sensory ganglia after primary infection. The incidence and severity of HZ increase during immunosuppression. Especially, immunocompromised patients are at high risk of developing a cutaneous rash and suffering from delayed healing of lesions. Bromovinyl deoxyuridine (brivudine), one of the most potent oral inhibitors of VZV replication, is widely used in the therapy of HZ in adult patients, particularly in Europe. In this study, we investigated the efficacy of brivudine in immunocompromised children to provide an outpatient treatment option. Methods: In this retrospective study, we included 64 immunocompromised pediatric patients with a median age of 14 years. Forty-seven patients received immunosuppressive therapy as part of hematopoietic stem cell transplantation and 17 patients as part of chemotherapy. Primary diagnosis was made clinically by examining the nature and the localization of the skin lesions. Laboratory confirmation was conducted based on the detection of VZV DNA in vesicle fluid and blood samples. Brivudine was administered orally at a single dose of 2 mg/kg per day. We monitored the patients’ response for the full time of treatment and observed the time of full crusting of lesions, loss of crusts, and any adverse effects that occurred. Results: Patients received medication for 7–21 days (median: 14 days). All children responded promptly to antiviral treatment and recovered completely from their HZ infections without complications. Crusting of lesions was reached after 3–14 days (median: 6 days). Full healing of skin lesions was ascertained within 7–21 days (median: 12 days). Overall, brivudine therapy was well tolerated. No clinical side effects during or after the treatment were observed. High compliance was achieved due to the once-daily dosing regimen. All patients were treated in an outpatient manner. Conclusion: Oral brivudine was a very effective and well-tolerated therapy in immunocompromised children with HZ infection. The oral administration offers the potential for outpatient treatment of HZ in these patients.

Effect of Herpes Zoster Treatment and Sudden Sensorineural Hearing Loss Using National Health Insurance Claims Data of South Korea.

Background and objectives: Herpes zoster (HZ) is caused by the reactivation of a pre-existing latent varicella zoster virus, which is one of the viruses that causes hearing loss, and hearing loss may occur due to a systemic immune response even if it does not invade the auditory nerve. This study aimed to determine the correlation between sudden sensorineural hearing loss (SSNHL) in older adult patients who received HZ treatment. Materials and Methods: We used the cohort data of patients aged 60 years and above (n = 624,646) between 2002 and 2015 provided by the National Health Insurance Service. The patients were divided into two groups: those who were diagnosed with HZ between 2003 and 2008 (group H, n = 36,121) and those who had not been diagnosed with HZ between 2002 and 2015 (group C, n = 584,329). Results: In the main model (adjusted HR = 0.890, 95% CI = 0.839-0.944, p < 0.001) adjusted for sex, age, and income, and the full model (adjusted HR = 0.894, 95% CI = 0.843-0.949, p < 0.001) adjusted for all comorbidities, group H had a lower risk of SSNHL than group C. Conclusions: This study showed that patients who received HZ treatment had a lower incidence of SSNHL within five years after diagnosis.

Herpes zoster in a 4-year-old child with pulmonary tuberculosis: a case report

Herpes zoster (HZ) is a dermatomal virus infection caused by the reactivation of latent varicella zoster virus (VZV) in sensory ganglia neurons that is previously exposed to primary varicella infection. Herpes zoster is a rare disease experienced in children and is often associated with an immunocompromised condition. A case of a girl four years old with a vesicle on the right chest which spread to the upper armpit and right inguinal was reported. The lessions were obtained on Thoracoaxilla as high as T4 and Inguinal as high as L1 dextra. The patient was treated with acyclovir doses of 30 mg/Kg/day for seven days and showed significant improvements.